How Financialization Reshapes Public Health Care Systems - The Case of Assurance Maladie

This article seeks to show how financialization is reshaping Public Health Care Systems (PHCS). To do so, we combine a theoretical discussion and an empirical investigation to examine the increasing participation of financial actors and instruments in these systems over the last decades. In the first part, we present the conventional approach for assessing PHCS transformation to date and argue for the need to incorporate the concept of 'financialization'. In the second part, we suggest a method for empirically examining how financialization alters the internal structures and organization of PHCS. In the last part, we apply this method to conduct an in-depth analysis of the French public health system, Assurance Maladie (AM). Our findings provide robust evidence that financialization had a major influence in the direction taken by the post-1990s reforms in this case, with new strategies allowing the increased participation of financial capital in the system's long-term, short-term, and investment financing. In the conclusion, we provide a critical assessment of financialized strategies, highlighting their adverse impacts on core principles of PHCS such as solidarity, stability, and democratic participation.